Individual
DR. PREMKUMAR RAJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3415 MACCORKLE AVE SE, CHARLESTON, WV 25304-1334
(304) 388-1790
(304) 388-1795
Mailing address
PO BOX 896158, CHARLOTTE, NC 28289-6158
(304) 388-1790
(304) 388-1795
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
21336
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2006367000
—
WV
Enumeration date
04/27/2006
Last updated
06/23/2021
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